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Magnet Technology at the MIT Plasma Science and Fusion Center

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Magnet Technology at the MIT Plasma Science and Fusion Center Magnets and Cryogenics Division Superconducting Cyclotrons for Hadron Radiotherapy J. V. Minervini1, Member, IEEE, A. Radovinsky1, P. C. Michael1, D. Winklehner2, and L. Bromberg1 with thanks to Dr. Eric Forton, IBA for background information on hadrontheray European Conference on Applied Superconductivity (EUCAS) 17-21 September 2017, Geneva, Switzerland 1Massachusetts Institute of Technology, Plasma Science and Fusion Center 2Massachusetts Institute of Technology, Department of Physics, Laboratory for Nuclear Science Cambridge, MA, USA Outline • What is hadron radiotherapy • Present and future outlook • Cyclotrons for PBRT • Superconducting cyclotrons • Ironless, variable energy, superconducting cyclotron • Summary J.V. Minervini MIT-PSFC Conventional Radiation Therapy vs. Hadrontherapy • Most conventional radiation therapy and arc therapy systems use Xrays of a few MeV for cancer treatment • Dose is not delivered to tissues by the photons themselves, but rather through secondary electrons produced by 3 mechanisms G.F. Knoll – Radiation detection and measurement, Wiley 3 Conventional Radiation Therapy vs. Hadrontherapy • Results in: ⁃ A decrease of photon numbers following a superimposition of decreasing exponentials ⁃ Some electron buildup => dose builds-up and then ~exponentially decreases with depth once electron equilibrium is reached Image courtesy of http://radiologykey.com/radiation-oncology/ 4 Conventional Radiation Therapy vs. Hadrontherapy • Instead, hadrons lose their energy in matter according to Bethe-Bloch formula. • In short, it results in the famous «bragg peak» dose distribution 5 G.F. Knoll – Radiation detection and measurement, Wiley As a result: • Hadrons offer the following advantages: Little radiation before the tumor No/little radiation at all beyond the tumor => Lower integral dose per treatment • Leading to potential clinical advantages: Up to 50% reduced risk of radiation- induced secondary cancer Drastically lower risk of adverse effects (treatment toxicity, side effects, 6 growth abnormality) – better quality of life PBS – Pencil Beam Scanning • Advantages: — Good 3D dose conformity — “Flexible” — Low neutron dose — No need for patient specific aperture • Disadvantages: — Dynamic system, less safe than passive system — Layer by layer, slower than scattering — Lateral penumbra less sharp than with collimation scattering PBS Examples Irradiation of surrounding tissues - Hepatocellular carcinoma Dose to critical Proton Therapy Arc Therapy Tissues (mean Photons Protons dose) Right Kidney 20 Gy 0.1 Gy Lung 12.5 Gy 8.5 Gy “PBT was found to be a safe and effective local-regional therapy for inoperable HCC. A randomized controlled trial to compare its efficacy to a standard therapy has been initiated” (*) 8 Images Courtesy of Stefan Both, Ph.D -- PENN Radiation Oncology (*) Bush DA, et al., « The safety and efficacy of high-dose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial. » Cancer. 13 (2011) 3053. Irradiation of Surrounding Tissues - Prostate IMRT Proton Therapy Dose to critical tissues (mean Photons Protons dose) Rectum 20 Gy 6.5Gy Bowel 18 Gy 10 Gy “Early outcomes with image-guided proton therapy suggest high efficacy and minimal toxicity with only 1.9% Grade 3 GU symptoms and <0.5% Grade 3 GI toxicities” (*) 9 Images Courtesy of Stefan Both, Ph.D - PENN Radiation Oncology (*) Mendenhall NP, et al. « Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer” Int J Radiat Oncol Biol Phys. 82 (2012) 213. Rhabdomyosarcoma – Side effects X-Rays Proton Therapy “Fractionated proton radiotherapy is superior to 3D conformal photon radiation in the treatment of orbital RMS (…) Proton radiation therapy minimizes long-term side effects” (*) Images Courtesy Torunn I Yock, MD -- Burr Proton Therapy Center Boston USA (*) Yock, T. et al; « Proton radiotherapy for orbital rhabdomyosarcoma: clinical outcome and a dosimetric comparison with photons. », Int J Radiat Oncol Biol Phys. 63 (2005) 1161. 10 Pediatric medduloblastoma – Side effects Side Effects Protons Photons Restrictive Lung Disease 3D CRT Proton Therapy 0% 60% Reduced exercise capability 0% 75% Abnormal EKGs 0% 31% Growth abnormality 20% 100% IQ drop of 10 points at 6 yrs 1.6% 28.5% Risk of IQ score < 90 15% 25% “Proton beam therapy has become a standard of care for pediatric cancers… ” (*) (*) Presentation Dr. Jay S. Loeffler, NPTC/MGH, ASTRO 2001 11 Growing Interest in Proton Therapy Clinical Advantages Oct. 2015 data from a leading center in the US 12 Increasing Relevance of Proton Therapy. Cumulative number of PT publications 3000 +13 in 2015 vs 2500 previous year 2000 1500 Publications 1000 500 0 1969 1974 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 Data from https://clinicaltrials.gov/ 1962 Pubmed search with: Proton Therapy or Proton Radiotherapy or Proton Beam Therapy 13 Market Growth: 2016-2021-2030 Worldwide # Rooms/Year 70 CAGR 120 +10% 2016 – 2030 60 52 50 47 43 Rooms 40 40 38 120 34 Per Year 30 28 19 RT Patients 20 6% Treated 10 0 Billions 2014 2015 2016 2017 2018 2019 2020 2021 … 2030 2.5 Order Intake 14 Many Systems Operating 15 Commercial systems at a glance, by geography (2016) IBA Number of Rooms - US Number of Rooms – EMEA + ROW HITACHI 18% 22% VARIAN 4% 38% 8% 58% 4% MEVION 48% PROTOM Number of Rooms - Japan Number of Rooms – Rest of APAC MELCO 2% SHI 15%13% 21% 31% Commercial systems acc. since 1996 since acc. systems Commercial 9% PRONOVA 6% 7% 41% 55% AVO 16 Typical Systems - Protons Proteus®PLUS Proteus®ONE 360 m² 1800 m² 17 Carbon and Heavy Ion 18 18 Major components (IBA ProteusONE) A rotating gantry to set the beam at the Compact super-conducting right angle accelerator for producing the energetic proton beam Intensity-modulated proton therapy (IMPT) : the most precise form of treatments Stereoscopic imaging and CBCT at isocentre: Efficient software integration, enabling easy & flexible workflows accurate patient setup, 19 quality images for adaptive treatments Summary: a typical system is composed of • An accelerator ⁃ Fixed energy (i.e. cyclotrons) => requires energy modulation and selection ⁃ Variable energy (synchrotrons) • A beam transport ⁃ Fixed beam (eye treatment) ⁃ Most usually a gantry able to deliver the beam at various angles ⁃ With PBS as most relevant treatment modality today • A treatment room ⁃ Patient positioning robot ⁃ Rough patient alignment systems (e.g. lasers) ⁃ Imaging systems (Xray, CBCT, CT) • A treatment control room • A therapy safety system, software 20 Accelerators in PT • (rough) requirements ⁃ Max. energy: 230 (250 MeV) protons – 400 MeV/u carbon ions ⁃ Min energy: ~70 MeV protons ⁃ At least 2 Gy/l/min => a few nA average beam current at nozzle level ⁃ Fast beam intensity modulation . In development or for the (far) future: ⁃ Minimum footprint . Linacs ⁃ Minimum energy consumption . Wakefield accelerators . Cyclinacs • Currently available on the market ⁃ Synchrotrons Beam accelerated on a single path, magnetic field is ramped =>Variable energy, pulsed beam, multiple-stage ⁃ Cyclotrons and synchro-cyclotrons Acceleration on a spiral path, fixed magnetic field => Usually fixed energy, CW or pulsed (high rep. rate), single stage 21 Synchrotrons Hitachi “PIMMS” (CERN) design . 70-150 MeV protons . Up to Carbon . Slow cycle . 25 m Diameter . 7 m Diameter . Rep. rate: 5 Hz . Installed @CNAO, Medaustron http://www.protominternational.com/about/about-radiance-330/ Rossi, EurPhysJPlus2011-126-78.pdf 22 Trend is toward more compact machines to reduce costs Protom . Up to 330 MeV protons . 5 m Diameter, ~16 tons . Being installed @MGH http://www.protominternational.com/about/about-radiance-330/ 23 Challenges and Trends in PT • Cost & Affordability (multirooms towards 1-2 rooms; cost of a fraction) • IMPT - scanning ⁃ Speed of treatment ⁃ Even faster with continuous line scanning? • Image guidance and Treatment robustness (leverage on sharp dose distribution) ⁃ Setup errors, Intra-fraction changes, Organ motion management ⁃ Inter-fraction changes, Adaptive treatments Offline Online with as little additional imaging dose as possible ⁃ In Vivo & real time range verification • Complexity, and so forth… Sustainability, too 24 Cyclotrons basic principles • If you neglect relativistic effects, a charged particle in magnetic field orbits at a constant frequency fp = ω / 2π = q B / 2π m 25 Commercial PBRT Cyclotrons IBA C230 Varian-Accel Probeam Mevion SC250 IBA S2C2 . 230 MeV protons . 250 MeV protons . 250 MeV protons . MeV protons . 4.3 m Diameter . 3.1 m Diameter . ~1.5 m Diameter . 2.2 m Diameter . CW beam . CW beam (shield) . Rep. rate: 1 . Normal conducting . Superconducting . Superconducting kHz . Magnet: 200 kW (NbTi) . Superconduc (Nb3Sn) . RF: 60 kW . Magnet: 40 kW ting (NbTi) . RF: 115 kW . RF: 11 kW 26 Proton cyclotrons - Ongoing developments • Isochronous: SHI, Varian/Antaya, Pronova/Ionetix, Heifei/JINR Ant Derenchuck - NAPAC 2016 Karamysheva - THP20 cyclotrons 2016 Antaya – CAS 2015 SHI Pronova/Ionetix Heifei/JINR Varian/Antaya . 230 MeV protons . 250 MeV protons . 200 MeV protons . 230 MeV protons . 2.8 m Diameter . 2.8 m Diameter . 2.2 m Diameter . 2.2 m Diameter . CW beam . CW beam . CW beam . CW beam . Superconducting . Superconducting . Superconducting . Superconducting (NbTi) (Nb Sn) (Nb3Sn) . 30 tons 3 . 55 tons . 60 tons . 3.6 T (extr.) . 30 tons+ . 4 T (extr.) . 3.7 T (extr) . 5.5 T (extr.) . “Flutter” coils 27 Mevion S250 Cyclotron Weight ~25 t J.V. Minervini MIT-PSFC Comparison of
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